Document 6432765

DEADLINE FOR
APPLICATION IS
MA Y 9 , 2 0 1 4
For this award,
submit materials to:
Attn: S. Pedersen
C/O United Way Washtenaw County
2305 Platt Rd.
Ann Arbor, MI 48104
Questions?
Sheila Pedersen
734-677-7218
www.uwwashtenaw.org
What to expect after you apply:
You will be notified of your status no
later than May 30, 2014. Varsity
Letters will be awarded at a dessert
reception in early June and you will
receive a formal invitation (location
Varsity Letter
In Community
Service
2013-2014 School Year
Each year, United Way of Washtenaw County partners with
Washtenaw County schools to recognize and reward
students for their volunteer efforts in the community.
Students who volunteer 145 or more hours of service in
a year can earn their school varsity letter, the same as
those earned by athletes and musicians. Applicants
must meet the following basic qualifications:
Be a student in grades 9-12 in Washtenaw County
Complete at least 145 hours of community service from
May 1, 2013 to April 30, 2014
At least 50 of the total hours MUST be in non-school
related activities
Have at least one school related volunteer activity
All volunteer activities must be verifiable
Your application must be RECEIVED by May 9, 2014
and date TBD).
VISIT US ONLINE FOR A FULL LIST OF
REQUIREMENTS AND INSTRUCTIONS AT
WWW.UWWASHTENAW.ORG OR CALL
(734) 677-7218 FOR MORE INFORMATION.
Varsity Letter in Community Service
Student Applicant Information
Deadline for Application May 9, 2014
First Name
Last Name
High School
Expected Graduation Year
Mailing Address
City
Cell (
Zip
)
Home Phone (
)
Email
(For notification purposes)
* * * S e n i o r s q u a l i f y t o a p p l y f o r t h e L a b o r a n d S c h o o l C o m m u n i t y S e r vi c e S c h o l a r s h i p . P l e a s e
contact United Wa y o ffice for instruction s.
____ I have previously received my Varsity Letter in
Community Service
____ I have previously received my Varsity Letter
for a different activity
____ I have never received my High School’s
Varsity Letter for any activities
How many hours did you volunteer?
______ Total number of hours served through
school related activities
+_____ Total number of hours served outside of
school activities (non-school related)
=_____Total number of hours served between
I attest that I performed the documented hours of
5/01/13 and 4/30/14 (Must be at least 145)
community service included in the attached verification
forms and met all the qualifications as outlined by United Way of Washtenaw County on the web site. To my
knowledge, these hours are valid and count toward my earning the Letter in Community Service.
Student Signature__________________________________________________ Date
Parent/Guardian
Please read the passage below and sign giving your child permission to participate in this award program.
I hereby assign to United Way of Washtenaw County all rights to video and audio recordings and all photographs of my
child made in connection with Letter in Community Service activities. I hereby authorize editing, duplication, reproduction,
copyright, exhibition, broadcast and/or other use and distribution of such recordings or quotations for purposes deemed
suitable by United Way of Washtenaw County. I also waive any right to approve or disapprove the finished products.
Parent/Guardian Name
___
Parent Guardian Signature___________________________________________ Date
We would like the opportunity to keep you informed of our programs, and would like to add you to our mailing list (which is
not shared with others). If you prefer not to be added please check the box below.
Please do not add me to the mailing list
Varsity Letter in Community Service
Community Service Verification Form
Deadline for application May 9, 2014
A copy of this form must be completed for each agency/organization/school/club for which you have performed service, so
duplicate this page as necessary. (i.e. only one form is needed with the total # hours spent with Key Club). Remember to
apply enough postage when mailing your application; standard postage is often not adequate.
We do not require the signature of your volunteer supervisor to verify your hours. We will however be contacting
them by phone and/or email to verify 100% of all hours submitted. Be sure to tell them that a United Way
Staff or volunteer will be contacting them in April to verify your hours.
This form must be filled out completely and legibly to be accepted and processed. If we cannot reach your supervisor to
verify your hours we will not be able to process your application. We recommend including every possible contact method
(cell, email etc) to ensure we are able to fully process your application.
Hours Completed for this Opportunity
Student Name __________________________
Organization, club or school name that you volunteered with:
This opportunity is (please mark one):
___school related
___non-school related (outside of school activities)
Please give the month, day and year that you volunteered with this opportunity. For ongoing service please
list your start and end dates below.
Date(s) volunteer service occurred
Brief description of volunteer work you performed: (You may attach additional sheets if this space in not adequate)
VERIFICATION CONTACT INFORMATION (Please PRINT all information clearly)
Note: You do not need all areas filled out. Please provide as much contact information as your supervisor wishes to share.
Adult Supervisor Name
Organization____________________________________Title
EMAIL
WORK Phone (
CELL Phone (
)
)
Best time/method to be contacted
HOME Phone(
)
Academic Eligibility
This form must be completed and returned with your application in order for it to be processed.
Youth United requires students earning their Varsity Letter in Community Service to be in good standing with
the school they attend. Students receiving their letters must meet the same academic requirements and
eligibility guidelines as other Varsity Letter recipients as they are set forth by their school.
United Way of Washtenaw County requires that Varsity Letter in Community Service recipients maintain at
least a 2.0 Grade Point Average (GPA).
The grade eligibility check must be completed by an appropriate staff member. In most schools this may be
the athletic secretary. If you are unclear on whom this person is, please ask in the main office.
It is important to remember: This may take a few days to process. Do not wait until the last minute to get
this form signed. Please complete the following form and return it with your Varsity Letter in Community
Service application. We will not be able to process ANY application without a signed eligibility form.
Student Name (Print) ___________________________________________________________________
School _______________________________________________________________________________
I verify that, as of (date) ________________, the above listed student meets the academic eligibility standards
and good standing requirements as set forth by (school name) _____________________ and the 2.0 GPA
requirement set forth by United Way of Washtenaw County.
Staff Name (Print) ______________________________________________________________________
Staff Signature ________________________________________________________________________
Work Telephone __________________________
Varsity Letter in Community Service
Community Service Log Sheet (optional)
Deadline for application May 9, 2014
This form does not need to be turned in with the rest of your application, although it will be accepted. It is
intended to help you track your volunteer hours and may be duplicated as needed. An example is included.
All of your service hours must occur between May 1, 2013 and April 30, 2014 for this award.
Name
Date
Service Opportunity
Advisor/Supervisor Name
Number
of hours
5/15/13
Key Club Meeting
Mrs. Feider
2
Hours related to:
school
non-school
X
Varsity Letter in Community Service
Frequently Asked Questions
The requirements state that I have to complete at least 50 hours in a “non-school activity”. What type of volunteer
work counts as a non-school activity?
• Gift shop clerk or assisted patients at a local medical facility
• Stocking and distributing food at a food bank
• Mentoring a child
• Environmental restoration work through a local non-profit
• Volunteering with a non-profit organization
These are just a few ideas, there are many ways to volunteer in your community. If you have questions about counting hours done
in a non-school related activity, contact us.
The requirements state that I have to complete at least one “school activity”. What type of volunteer work counts as
a school activity?
The following is a list of activities that can be done in school:
• Participating in a community service project through a school club
• Assisting a teacher before/after school or during the summer
• Volunteering with a parent organization within the school
• Volunteering as a student athletic trainer (if not required for a class)
• Assisting at sporting events, concerts, theater productions (if not required for a class)
• Tutoring peers
These are just a few ideas, there are many ways to volunteer in your school. If you have questions about counting hours done in a
school related activity, contact us.
I volunteered on a mission trip through my church, how do I count these hours?
If you volunteer on a mission trip or other volunteer vacation, the hours are calculated as follows:
During the school year: 10 hours per day
During the summer: 15 hours per day
If you have documentation proving that you served more than these hours per day, you may submit it with your application and will
be credited with these hours if we are able to verify them with your provided contact.
I volunteered as a camp counselor, how do I count those hours?
If you volunteer as a camp counselor, the hours are calculated as follows:
During the school year: 10 hours per day
During the summer: 15 hours per day
If you have documentation proving that you served more than these hours per day, you may submit it with your application and will
be credited with these hours if we are able to verify them with your provided contact.
Can I count hours from club meetings?
If you participate in a school club, you may count any hours that are spent organizing and implementing a service project. If you are
in a club that uses meeting times to discuss other club business, you may not count those hours. Only hours spent planning and
participating in a service project will count as community service hours.
I have to complete community service hours so that I can graduate, can I count these hours towards my Varsity
Letter?
Any community service or volunteer hours done to meet a graduation requirement DO NOT count towards your Varsity Letter in
Community Service. Volunteer hours that are counted for the Varsity Letter are to be done above and beyond what is required for
graduation.
I have to complete community service hours for a class, can I count these hours?
Any community service or volunteer hours done as a requirement for a class, DO NOT count towards your Varsity Letter in
Community Service. Volunteer hours that are counted for the Varsity Letter are to be done above and beyond what is required for a
class.